Healthcare Provider Details

I. General information

NPI: 1851159602
Provider Name (Legal Business Name): JUSTIN CASTELLANO OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 SE CENTRAL PKWY
STUART FL
34994-3919
US

IV. Provider business mailing address

6271 CHASEWOOD DR APT G
JUPITER FL
33458-5802
US

V. Phone/Fax

Practice location:
  • Phone: 954-789-1085
  • Fax:
Mailing address:
  • Phone: 631-338-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT24988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: